Bowel Obstruction

What is a bowel obstruction?

The term bowel obstruction simply describes that the passage of food in the bowel is obstructed. This can occur in the small bowel (most often), called small bowel the obstruction, or in the large bowel (not as common), called large bowel obstruction. It also can be congenital in a newborn or acquired in an adult.

What conditions contribute to bowel obstructions in newborns?
The following conditions contribute to bowel obstructions in newborns:

Anal Atresia

Occasionally a baby is born where the anal opening is missing. This is called anal atresia. It is a developmental anomaly where a membrane that was there when the baby was in the womb has not disappeared. This is considered an emergency that must be dealt with immediately. If it is missed on day one, it will develop into acute bowel obstruction with abdominal distension, pain and vomiting on day two. Usually the physician picks up the problem with the initial examination of the newborn right after delivery and then arranges a referral to a pediatric surgeon immediately. If it is a small problem, a minor surgery opens the anal canal. However, often there are other anomalies of the lower urinary tract and of the vagina. Occasionally the surgeon will decide to perform a preliminary colostomy to relieve the obstruction. At a future date when the child has grown and the tissue structures are bigger, the definite corrective surgery can be done with less fear of excessive scarring.

Bowel Atresia

Obstructions can occur in other parts of the gut, most commonly in the last part of the small bowel (ileum), followed by the duodenum, the upper part of small bowel (jejunum) and the colon. Symptoms are dictated by the location of the atresia. A high atresia leads to regurgitation and vomiting much earlier. With an atresia of the small bowel the symptoms are that of small bowel obstruction. Finally, with colonic atresia the symptoms are those of large bowel obstruction with less violent symptoms, less fluid problems and vomiting at a later time than with small bowel obstruction.

Hirschsprung’s Disease (Megacolon)

This disease involves a segment of colon that has a congenitally absent nerve network (plexus). It may go unnoticed first, but as time progresses, the infant becomes more and more constipated. There is also bowel swelling in the left lower and mid abdomen as the stool is building up. The risk is that a megacolon develops, which in time becomes filled with toxic substances and infection (toxic megacolon). The infant or older child may fail to thrive, have no appetite, have recurrent left abdominal pain, and bowel swelling with visible snake-like movement of the bowel loop underneath the skin (peristalsis). This disease needs urgent attention by a pediatric surgeon.

The surgeon will either do a one-stage or two-staged procedure. In the one-stage procedure, usually when there is no toxic megacolon present, the surgeon removes the defective portion of the colon and repairs the normal colon. With a two-staged procedure the first stage is to do a colostomy. This reestablishes normal emptying of the bowel contents. The colostomy is covered with a bag that is changed regularly. At a future date when the megacolon has settled down the resection of the defective part is removed. This breaks down the high-risk surgery into two stages raising the survival chance for the patient. When all is done, the infant grows normally and has a normal life expectancy.

Hypertrophic Pyloric Stenosis

With this condition, the baby usually feeds well until the fourth to sixth week and then suddenly starts vomiting after every feeding. Within a short period of time there is projectile vomiting. This is due to a thickened (hypertrophic) outlet from the stomach. The baby has abdominal pain and eventually no food will pass leading to severe dehydration quickly. These infants require emergency attention at the hospital with a referral to a pediatrician and pediatric surgeon. A surgery involving a relatively small incision will be made to correct the problem. These infants do very well following this procedure.

Meconium Plug Syndrome

Meconium is the name for the first stool of a baby. It looks dark green, sometimes almost black and is of a tarry, pasty consistence. In babies with cystic fibrosis the meconium that is formed in the stomach is more tenacious, stickier and can get stuck before it reaches the colon. This meconium plug is the reason for a dangerous syndrome where a bowel obstruction develops, but the colon is empty and normal. The diapers do not show bowel movements, but the small bowel shows dilated bowel loops, which very quickly leads to fluid imbalances in the blood stream. A pediatrician needs to stabilize the baby’s condition and diagnose the bowel obstruction due to the meconium plug syndrome. A cheap nba jerseys pediatric surgeon is required to see whether the plug will resolve with diluted enemas or whether it will require surgery.

What conditions contribute to bowel obstructions in adults?

In adults, the causes of bowel obstruction are not usually congenital in nature, but are acquired. A common classification is to distinguish between small and large bowel obstruction.

Small bowel obstruction

A small bowel obstruction is more acute in its presentation as a lot of fluid can be lost into dilated small bowel loops. There might have been a history of prior surgery and bands of scar formation (adhesions) that have developed. These bands of scarring are made up of tough connective tissue and attach to bowel loops from outside like suction devices that won’t let go. As the years go by, the adhesion tissue loses water and retracts thus leading to kinking of the attached bowel loops. This is when small bowel obstruction suddenly develops.

What are the signs and symptoms of a small bowel cheap MLB Jerseys obstruction?

Symptoms can begin with the patient feeling discomfort after meals for a few months or even years. This settles for a while and then begins to affect the patient with acute abdominal pain in the right and central abdomen, somewhat dictated where the obstruction is. If there is a volvulus present, the symptoms are more pronounced and there is a higher priority for the physician fake oakleys to get in and cheap football jerseys rescue the bowel. There are only up to 6 hours before the bowel becomes gangrenous and there is a danger of perforation and an infection in the abdominal cavity (peritonitis). Abdominal x-rays often show a ladder like formation of bowel loops with fluid levels in the standing views.

How is a small bowel obstruction treated?

It is important to get ray ban outlet an assessment by a surgeon early on in these cases. A surgical opening of the abdominal cavity (laparotomy) is arranged, which usually shows the cause of the obstruction right away. About 25% to 30% of the small bowel obstructions are strangulating. The surgical procedure depends on the findings during the laparotomy and on the status of the patient at the time of surgery. Often there might have to be a period of two to three hours prior to surgery where the bowel is decompressed by placing a drainage tube first, replacing the fluid loss and balancing the electrolytes based on blood tests. When the patient is stabilized in this manner, the surgical procedure is safer and the complication rate is lower.

Large bowel obstruction

A bowel obstruction of the large intestine (colon) is not as acute as that of the small bowel. Causes of a large bowel obstruction include diverticulitis, a cancerous growth inside the colon, Crohn’s disease and volvulus.

What are the signs and symptoms of a large bowel obstruction?

In the case of a large bowel obstruction there is usually an increasing constipation problem and blood in the stool. A volvulus has a different, more acute presentation as the strangulation leads to excruciating abdominal pain. Depending on the underlying cause, the symptoms are slightly modified.

How is a large bowel obstruction treated?

Treatment is similar to small bowel obstruction in that the patient has to be stabilized first and then a laparotomy is performed to inform the surgeon what is occurring and which procedure to use to correct it. A cancer would be removed in the healthy adjacent colon and the two ends be reconnected. Similarly, with diverticulitis the affected colon segment has to be removed and the healthy colon ends are connected.

More information about bowel obstruction

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